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特重度烧伤患者早期发生严重低钙血症的影响因素与临床意义

Influencing factors and clinical significance of severe hypocalcemia in patients with extremely severe burns in early stage

摘要:

目的 分析特重度烧伤患者早期发生严重低钙血症的影响因素与临床意义. 方法 2010年1月-2015年7月,笔者单位收治的142例特重度烧伤患者符合研究入选标准,对其病历资料进行回顾性分析.(1)统计入院时低钙血症和严重低钙血症发生情况.(2)根据性别将患者分为男性组113例和女性组29例,比较2组患者中年龄>55岁和≤55岁者的入院血钙水平,对数据行t检验.(3)根据入院血钙水平,将患者分为严重低钙血症组52例和非严重低钙血症组90例,比较2组患者性别、年龄、火焰烧伤情况、烧伤总面积、吸入性损伤情况、入院时间以及入院pH值、白蛋白水平,对数据行x2检验、t检验.选取P<0.1的指标,行多因素logistic回归分析,筛选特重度烧伤患者早期发生严重低钙血症的影响因素.(4)根据预后情况,将患者分为存活组112例与死亡组30例,比较2组患者性别、年龄、火焰烧伤情况、烧伤总面积、吸入性损伤情况、入院时间以及入院时血钙水平、pH值、白蛋白水平,对数据行x2检验、t检验.选取P<0.1的指标,行多因素Cox回归分析,分析影响特重度烧伤患者预后的因素. 结果 (1)入院时142例患者中共138例发生低钙血症,占97.2%,其中严重低钙血症患者52例,占36.6%.(2)男性组年龄>55岁患者入院血钙水平为(1.84±0.19) mmol/L,与组内年龄≤55岁患者的(1.88±0.21) mmol/L及女性组年龄>55岁患者的(1.96±0.13) mmol/L相近(t=0.833、1.560,P>0.05).女性组年龄≤55岁患者入院血钙水平为(1.78±0.19) mmol/L,显著低于男性组年龄≤55岁患者及女性组年龄>55岁患者(t=-2.197、-2.472,P <0.05).(3)非严重低钙血症组患者烧伤总面积及吸入性损伤比例明显小于严重低钙血症组(t=2.379,x 2=13.410,P<0.05或P<0.01),入院时间明显早于严重低钙血症组(t=2.675,P<0.01),入院白蛋白水平明显高于严重低钙血症组(t=-6.163,P<0.01).2组患者性别、火焰烧伤情况、年龄、入院pH值相近(x 2=1.869、2.850,t=-0.578、0.645,P>0.05).多因素logistic回归分析显示,仅入院白蛋白水平是特重度烧伤患者发生严重低钙血症的独立影响因素(比值比为1.179,95%置信区间为1.092 ~1.273,P<0.01).(4)存活组患者烧伤总面积、吸入性损伤比例明显小于死亡组(t=-5.515,x2=27.573,P<0.05或P<0.01),入院pH值及入院白蛋白水平明显高于死亡组(t=2.208、3.321,P<0.05或P<0.01).2组患者性别、火焰烧伤情况、年龄及入院时间、入院血钙水平相近(x2 =0.198、2.545,t=-1.316、-1.397、1.857,P>0.05).多因素Cox回归分析显示,烧伤总面积和吸入性损伤是预测特重度烧伤患者预后的独立危险因素(相对危险度为1.066、4.081,95%置信区间为1.023~1.110、1.144 ~14.559,P<0.05或P<0.01),入院pH值、白蛋白及血钙水平不是预测患者预后的独立危险因素(相对危险度为0.003、1.025、0.634,95%置信区间为<0.001 ~1.183、0.956 ~1.099、0.055 ~7.321,P>0.05). 结论 大部分特重度烧伤患者入院时血钙水平即显著降低,尤其是≤55岁女性患者;相较于非严重低钙血症患者,严重低钙血症患者烧伤总面积更大,吸入性损伤比例更高,入院时间更晚且入院门蛋白水平更低,但只有入院白蛋门水平是患者发生严重低钙血症的独立影响因素;入院血钙水平并不能预测特重度烧伤患者预后.

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abstracts:

Objective To analyze the influencing factors and clinical significance of severe hypocalcemia in patients with extremely severe burns in early stage.Methods Clinical data of 142 patients with extremely severe burns admitted to our wards from January 2010 to July 2015,conforming to the study criteria,were retrospectively analyzed.(1) The incidence of hypocalcemia and severe hypocalcemia on admission were calculated.(2) Patients were divided into the male group (n =113) and the female group (n =29) according to gender.The levels of serum calcium of patients whose age more than 55 years old and less than or equal to 55 years old in the two groups were compared with t test.(3) Patients were divided into severe hypocalcemia group (n =52) and non-severe hypocalcemia group (n =90) according to the level of serum calcium on admission.The data including gender,age,flame burn,total burn area,inhalation injury,admission time,the pH value,and the albumin level of patients on admission between two groups were compared with chi-square test or t test.Indexes with P < 0.1 between two groups were selected,and multivariate logistic regression analysis was conducted to screen the influencing factors of severe hypocalcemia in patients with extremely severe burns in early stage.(4) According to the prognosis,patients were divided into survival group (n =112) and non-survival group (n =30).The data including gender,age,flame burn,total burn area,inhalation injury,admission time,the level of serum calcium,the pH value,and the albumin level of patients on admission between two groups were compared with chi-square test or t test.Indexes with P < 0.1 between two groups were selected,and multivariate Cox regression analysis was conducted to screen the influencing factors of prognosis of patients with extremely severe burns.Results (1) The incidence of hypocalcemia on admission was 97.2% (138/142),and patients diagnosed as severe hypocalcemia accounted for 36.6% (52/142).(2) In the male group,the level of serum calcium of patients with age more than 55 years old was (1.84 ± 0.19) mmol/L,which was close to (1.88 ± 0.21) mmol/L of patients with age less than or equal to 55 years old within the same group and (1.96 ± 0.13) mmol/L of patients with age more than 55 years old in the female group (t =0.833,1.560,P > 0.05).In the female group,the level of serum calcium of patients with age less than or equal to 55 years old was (1.78 ± 0.19) mmol/L,which was significantly lower than that of patients with age less than or equal to 55 years old in the male group and that of patients with age more than 55 years old in the female group (t =-2.197,-2.472,P < 0.05).(3) Compared with those of patients in severe hypocalcemia group,the total burn area and the proportion of inhalation injury of patients in non-severe hypocalcemia group were obviously smaller (t =2.379,x2 =13.410,P <0.05 orP <0.01),and the admission time was obviously earlier (t =2.675,P < 0.01),while the albumin level was obviously higher (t =-6.163,P < 0.01).There were no statistically significant differences between patients of the two groups in gender,flame burn,age,and the pH value on admission (x 2 =1.869,2.850,t =-0.578,0.645,P > 0.05).Multivariate logistic regression analysis showed that only the albumin level on admission was the independent influencing factor of severe hypocalcemia in patients with extremely severe burns (with odds ratio 1.179,95% confidence interval 1.092-1.273,P < 0.01).(4) Compared with those of patients in non-survival group,the total burn area and the proportion of inhalation injury in survival group were smaller (t =-5.515,x 2 =27.573,P < 0.05 or P <0.01),while the pH value and the albumin level on admission were higher (t =2.208,3.321,P < 0.05 or P < 0.01).There were no statistically significant differences between patients of the two groups in gender,flame burn,age,admission time,and the level of serum calcium on admission (x 2 =0.198,2.545,t =-1.316,-1.397,1.857,P > 0.05).Multivariate Cox regression analysis showed that total burn area and inhalation injury were the independent risk factors to predict prognosis of patients with extremely severe burns (with relative risk 1.066 and 4.081,95% confidence interval 1.023-1.110 and 1.144-14.559,P < 0.05 or P < 0.01),but the pH value and levels of albumin and serum calcium were not independent risk factors to predict prognosis of patients with extremely severe burns (with relative risk 0.003,1.025,and 0.634,95% confidence interval < 0.001-1.183,0.956-1.099,and 0.055-7.321,P > 0.05).Conclusions The level of serum calcium of the majority of patients with extremely severe burns on admission is decreasing significantly,especially the female patients less than or equal to 55 years old.Compared with non-severe hypocalcemia patients,patients with severe hypocalcemia are with larger total burn area,higher proportion of inhalation injury,later admission time,and lower albumin level on admission.However,only the albumin level on admission is the independent influencing factor of severe hypocalcemia in patients with extremely severe burns.And the level of serum calcium on admission can not predict the prognosis of patients with extremely severe burns.

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作者: 吴静 [1] 张勤 [1] 刘健 [1] 唐佳俊 [1] 郑捷新 [1]
期刊: 《中华烧伤杂志》2018年34卷4期 203-207页 MEDLINEISTICPKUCSCD
栏目名称: 重症烧伤
DOI: 10.3760/cma.j.issn.1009-2587.2018.04.003
发布时间: 2018-05-17
基金项目:
上海市市级医院新兴前沿技术联合攻关项目 Cooperative Research and Development Program of Emerging Frontier Technology of Shanghai Municipal Hospitals
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